South Carolina Life and Health Practice Exam

Group health plans may deny participation based on what criteria?

1. Member's employment status

2. Member's age

3. Member's part-time employment status

4. Member's previous insurance history

The correct answer is: Member's part-time employment status

Group health plans are designed to provide coverage to employees and their dependents based on specific criteria set by the employer and the insurance provider. One of the common practices is that these plans may limit participation based on whether a member is considered full-time or part-time. When a group health plan specifies that only full-time employees are eligible for coverage, it effectively denies participation to those who are classified as part-time employees. This criterion is significant because different employers may have varying definitions for what constitutes full-time work, often using a threshold of hours worked per week to determine eligibility. As a result, individuals who work less than this threshold, even if they are regular employees, may not be allowed to enroll in the group health plan. In contrast, criteria such as a member's age, prior insurance history, or employment status in a broader sense may not explicitly deny participation in the same way. For many group plans, age-related criteria can be irrelevant as they are typically designed to cover all employees regardless of age. Additionally, previous insurance history is often considered when an individual is applying for individual insurance rather than determining eligibility for a group plan.